RAYA'S PARADISE OF SAN CLEMENTE

Official classification

Type A

Official code

87507(g)(3)(B)(1)

Regulation authority

CCR

What the official deficiency says

Payment provisions, including the following: Rate for additional items and services, including: A comprehensive description of and the corresponding fee schedule for all additional items and services not included in the fees for basic services shall be listed. This req is not met as evidenced by: Based on record review and interviews conducted, Licensee failed to ensure additional charges were supported by the admission agreement. R1, R2, and R3 were either charged for items not on admission agreement or charged for services not provided which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to audit billing practices and provide refunds as indicated. Licensee to forward proof of correction to LPA by POC due date.

Deadline recorded: Aug 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This req is not met as evidenced by: Based on record review and interviews conducted, Licensee failed to ensure R1 and R2 were provided dignity at the facility. Facility staff accessed resident’s bank accounts and spent the resident’s funds for personal use. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

Official plan of correction

Licensee to provide refund to R1 and R2 and forward proof to LPA by POC due date.

Deadline recorded: Aug 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.38(b)(1)

Regulation authority

HSC

What the official deficiency says

A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party, if any, and the local long-term care ombudsman, within 10 days..: The department commences proceedings to suspend or revoke the license of the facility pursuant to Section 1569.50. This req is not met as evidenced by: Based on interviews conducted, Licensee failed to notify Ombudsman and responsible parties. Two out of two responsible parties and Ombudsman deny receipt of notification which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to notify all responsible parties, residents and Ombudsman and forward proof to LPA by POC due date.

Deadline recorded: Aug 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This req is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee failed to ensure care and supervision was provided to R1. R1 sustained an unexplained fracture as well as pressure injury while in care which poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

Official plan of correction

Licensee to provide an in-service on care and supervision including transfers and forward proof to LPA by POC due date.

Deadline recorded: Apr 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This req is not met as evidenced by: Based on record review and interviews conducted, Licensee failed to ensure R1 and R2 were provided dignity at the facility. Facility staff accessed resident’s bank accounts and spent the resident’s funds for personal use. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

Official plan of correction

Licensee to provide the plan to provide refunds to R1 and R2 and forward to LPA by POC due date. This is an amended report

Deadline recorded: Dec 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not ensure R1 was allowed to leave the facility. Facility staff prohibited R1 from leaving the facility with visitors. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to provide an in-service to all staff regarding resident rights including the ability to leave the facility and forward proof to LPA by POC due date.

Deadline recorded: Dec 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.269(a)(21)

Regulation authority

HSC

What the official deficiency says

Residents of residential care facilities for the elderly shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided. This requirement is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure that R1 was provided requested documents which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to provide an in-service on resident's access to records and forward proof to LPA by POC due date.

Deadline recorded: Jan 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This req is not met as evidenced by: Based on record review and interviews conducted, Licensee failed to ensure R1 and R2 were provided dignity at the facility. Facility staff accessed resident’s bank accounts and spent the resident’s funds for personal use. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

Official plan of correction

Licensee to provide the plan to provide refunds to R1 and R2 and forward to LPA by POC due date. This is an amended report

Deadline recorded: Dec 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not ensure R1 was allowed to leave the facility. Facility staff prohibited R1 from leaving the facility with visitors. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to provide an in-service to all staff regarding resident rights including the ability to leave the facility and forward proof to LPA by POC due date.

Deadline recorded: Dec 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.269(a)(21)

Regulation authority

HSC

What the official deficiency says

Residents of residential care facilities for the elderly shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided. This requirement is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure that R1 was provided requested documents which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to provide an in-service on resident's access to records and forward proof to LPA by POC due date.

Deadline recorded: Jan 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87205(a)

Regulation authority

CCR

What the official deficiency says

The licensee..., shall exercise general supervision over the affairs of the licensed facility.. concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This req is not met as evidenced by: Based on record review and interviews conducted, the licensee failed to ensure oversight was provided for facility operations resulting in multiple resident’s being financially abused and personal rights being violated.This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to forward a detailed written plan showing how the Licensee will provide oversight at the facility to prevent violations of department regulations.

Deadline recorded: Dec 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This req is not met as evidenced by: Based on record review, Licensee failed to ensure admission agreement was followed. R1 and R2's room rate was increased after 1 year when admission agreement stated increases after 2 years. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee revised billing system effective 01/2026.Licensee to forward letter to be sent to residents about change in system as well as information regarding the new system to LPA by POC due date.

Deadline recorded: Nov 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(8)

Regulation authority

CCR

What the official deficiency says

In addition to the rights... residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To be free from... financial exploitation... humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This req is not met as evidenced by: Based on record review and interviews conducted, Licensee failed to provide a refund to R1/ R2 which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to audit invoices and provide a refund to residents as necessary. Licensee to forward proof to LPA by POC due date.

Deadline recorded: Nov 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: Any incident which threatens the welfare, safety or health of any resident...This requirement is not met as evidenced by: Based on record review, Licensee failed to ensure incident regarding missing Morphine IN October 2024 was reported to the department. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to read regulation and provide a statement of understanding and forward proof to LPA by POC due date.

Deadline recorded: Aug 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This req is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1's Morphine Sulfate was in a safe and locked place. The medication was inadvertently given to R2's family. This poses an immediate health and safety risk to resident's in care.

Official plan of correction

Licensee to provide an in-service regarding resident discharge medication and forward proof to LPA by POC due date.

Deadline recorded: Aug 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

Prescription medications which are not taken with the resident upon termination of services.. or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years..This req is not met as evidenced by: Based on record review and interview, Licensee failed to ensure medication destruction is occurring with facility administrator and another adult and including two signatures. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee has developed paperwork to document the medication destruction. Licensee to forward revised medication destruction process to LPA by POC due date

Deadline recorded: Aug 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to... to the resident’s estate, within 15 days after the personal property is removed. This req is not met as evidenced by: Based on record review, Licensee failed to ensure a refund was paid to R1's family within 15 days of R1's belongings being removed after death. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to review the regulation and forward a statement of understanding to LPA by POC due date.

Deadline recorded: Aug 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources. Based on interviews conducted, Licensee failed to ensure R2's ring was safeguarded. R1 put R2's ring on and had to be cut off. Licensee did not compensate R2's family for the loss. This poses a potential health and safety risk to resident's in care.

Official plan of correction

Licensee to conduct an in-service with staff on safeguarding resident's belongings and forward proof to LPA by POC due date.

Deadline recorded: Aug 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in one out of four residents (R8) without physician orders for bed rails which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Licensee removed rails during the visit.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Per LPA's file review, there is no updated LIC 308 designating a back up for Administrator Westphaln. During the visit, facility did not have a back up administrator and the department initially met with a third party vendor to obtain documents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2025 Plan of Correction Facility to provide an LIC 308/ updated LIC 500 to LPA designating a back up administrator and forward to LPA by POC due date.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in three out of eight staff (S1-3) without first aid training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2025 Plan of Correction Licensee to provide first aid training to staff and forward proof to LPA by POC due date.

Official classification

Type A

Official code

87468.1(a)(14)

Regulation authority

CCR

What the official deficiency says

To have reasonable access to telephones, to both make and receive confidential calls. The licensee may require reimbursement for long distance calls. This requirement is not being met as evidenced by: Based on observation and interviews conducted, Licensee failed to ensure R1 had access to the resident's phone. Staff removed the resident's phone and LPA observed blocked family member's number on phone. This poses an immediate health and safety risk to resident's in care.

Official plan of correction

Licensee to conduct an in-service on personal rights and forward proof to LPA by POC due date.

Deadline recorded: Jul 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87217(d)(2)

Regulation authority

CCR

What the official deficiency says

Except as provided in approved continuing care agreements, no licensee or employee of a facility shall: accept any general or special power of attorney for any such person; This req is not being met as evidenced by: Based on record review and interview, Licensee failed to ensure an employee of the facility was not designated as a power of attorney for R1. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to read the regulation and forward a statement of understanding to LPA by POC due date.

Deadline recorded: Jun 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1 was provided care and supervision. R1 left the facility unattended to travel to another community. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to read the regulation and forward a statement of understanding to LPA by POC due date.

Deadline recorded: Jul 2, 2025. A deadline is not proof that correction was completed.